Pneumonectomy

Pneumonectomy

Anesthesia type	General
Airway	DL ETT
Lines and access	2x PIV, A-line typically
Monitors	Standard
Primary anesthetic considerations
Preoperative	Patients often smokers with COPD, may have poor reserve Fiberoptic cart should be available prior to induction
Intraoperative	Consider PC to limit peak pressures during one-lung ventilation
Postoperative	+/- chest tubes postoperatively
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A pneumonectomy is the surgical removal of an entire lung. It can be performed via VATS or thoracotomy.

Overview

Indications

• Lung cancer
• TB
• Severe COPD
• Bronchiectasis
• Lung abscess

Surgical procedure

• After a pneumonectomy, air fills the space previously occupied by the lung. This postpneumonectomy space (PPS) will change over time, as the body compensates with elevation of the hemidiaphragm, mediastinal shift towards the PPS, and hyperinflation of the remaining lung. At the same time, there is progressive resorption of the air in the PPS which is replaced with fluid.
• Postoperatively, a chest tube is NOT always inserted, and the air is not always evacuated.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary	May have poor reserve to begin. Many patients are smokers with COPD
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Operating room setup

• Have DLT (39F for males, 37F for females typically) available, as well as equipment to place it (video scope, fiberoptic bronchoscope to confirm placement)
• Have large hemostat or Kelly clamp to clamp DLT and drop or deflate the operative lung

Regional and neuraxial techniques

• Thoracic epidurals are common. Bolusing prior to incision helps with intraoperative and postoperative pain. (consider 5-8cc of 0.25% bupivacaine)

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications